VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Sunrise of Fairfax
9207 Arlington Boulevard
Fairfax, VA 22031
(703) 691-0046

Current Inspector: Marshall Massenberg (804) 543-5188

Inspection Date: Oct. 7, 2024 and Nov. 19, 2024

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Technical Assistance:

Documentation was discussed with the provider.

Comments:

Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 10/7/24 (2:00 PM - 4:00 PM), 11/19/24 (2:30 PM - 5:30 PM) The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 9/27/24 regarding an allegation in the area of: Resident Care and Related Services Number of resident records reviewed: One Number of interviews conducted with residents: One Number of interviews conducted with staff: One Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the allegation of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the complaint but identified during the course of the investigation can also be found on the violation notice. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) or law. If the licensee wishes to provide a plan of correction: (i) type the plan on a separate Word document, (ii) identify the standard violation number being addressed, (iii) include the date the violation will be corrected, (IV) do not include any names or confidential information, and (V) return to the licensing inspector by email within five (5) business days of the exit interview. Compliance with all applicable regulations and law shall be maintained and any areas of noncompliance must be corrected. Within 15 calendar days of your receipt of the inspection findings (inspection summary, violation notice, and supplemental information), you may request a review and discussion of these findings with the inspector's immediate supervisor. To make a request for review and discussion, you must contact the licensing supervisor at the regional licensing office that serves your geographical area. Regardless of whether a supervisory review has been requested, the results of the inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice. The department's inspection findings are subject to public disclosure. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Marshall Massenberg, Licensing Inspector at (804) 543-5188 or by email at marshall.x.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-70-A
Complaint related:	No
Description:	Based on documentation, the facility did not ensure that a report is made to the regional licensing office within 24 hours of any major incident that has negatively affected the life, health, safety, or welfare of any residents. Evidence: The record for Resident #1 was observed during the inspection. Facility staff observed a wound on Resident #1's coccyx on 9/21/24, according to a progress note. The staff member noted that Resident #1's skin is gone and that the resident's muscle tissue is visible. The record for Resident #1 contained a hospice note, dated 9/27/24, that discusses the presence of a stage four pressure wound. Stage four dermal ulcers are among the list of prohibited conditions, from ? 63.2-1805 D of the Code of Virginia, where residents shall not be admitted or retained if they have any of the listed conditions or care needs. The regional licensing office was not notified about the presence of a resident with a stage four pressure wound.
Plan of Correction:	The RCD will complete the initial 24 hour and the final 72-hour summary incident reports and turn them into the ED for submission to the licensing office.
Standard #:	22VAC40-73-470-F
Complaint related:	Yes
Description:	Based on record review, the facility did not ensure that each resident's physician and designated contact person are contacted within 24 hours, when the resident suffers a serious injury, illness, or medical condition. Evidence: A 9/21/24 progress note, included in the record for Resident #1, states that a staff member observed that the wound dressing on Resident #1's coccyx fell off during a brief change. The resident?s skin was reported to be gone and her muscle tissue was visible. The note indicated that the wound is being treated by hospice and the dressing was replaced. No note was observed in the record to indicate that the hospice company, Resident #1's physician, or designated contact person was notified about the condition of the wound. Hospice notes indicate that the next time that the hospice nurse treated the wound occurred on 9/23/24. On 9/23/24, Resident #1's wound had increased in size from 2.25 x 2.0 x1cm (on 9/18/24) to 7cm x 5cm x 1.5cm. On 9/27/24, Resident #1?s wound was documented as a stage 4 wound. Resident #1's progress notes indicated that her designated contact person and physician were not notified about the resident?s condition until 9/30/24.
Plan of Correction:	RCD and Wellness nurse will communicate with all designated contacts and physicians within 24 hours for any serious event along with providing regular updates outside of any hospice or home health communication. RCD/wellness nurse will complete weekly wound rounds on Wednesday and document and communicate updates timely.
Standard #:	22VAC40-73-580-E
Complaint related:	No
Description:	Based on record review, the facility did not ensure compliance with any needs prescribed by a physician or other prescriber. Evidence: Resident #1's record contained an order, dated 3/18/24, that called for the resident to be weighed weekly and that the physician be notified if the resident had any weight gain greater than five pounds or weight loss. Resident weight information was observed in the record for the following dates: 3/25/24, 4/1/24, 4/8/24, 5/3/24, 5/7/24, 6/2/24, 6/3/24, 7/3/24, 7/26/24, and 8/2/24. The resident record did not contain information to document that Resident #1's weight was taken weekly, as prescribed.
Plan of Correction:	Wellness team to audit orders for appropriateness and escalate to the physician any concerns such as mobility if unable to complete order as written.